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Dear Amstat News,
American Statistical Association members regularly pro- done right away (treatment cases) and those to be done
vide statistical services with the intent, as our ASA mission later (control cases).
statement states, “to use our discipline to enhance human Of course, the act of randomization is itself a meta-
welfare.” Some of these activities are done pro bono within treatment and needs to be fit into the culture you are work-
ASA chapters, such as judging at science fairs. Others are ing in—to be sold, not forced. We and our MCC client
done within ASA committees or sections. Many activities Paul Pleva are at this stage now. For more on the issues here,
are done outside of the ASA, too. see Chapter 12 of Statistical Methods and Human Rights by
In January, as part of an engagement for the Millennium Jana Asher, David Banks, and Fritz Scheuren (eds.).
Challenge Corporation (MCC), we began to measure the The following story was adapted from Chris Blattman’s
impact of attempts to ameliorate the AIDS epidemic in blog, “Economic Development, Political Change, and
Lesotho. Now, most of you may not know where Lesotho Conflict in the Developing World,” at http://chrisblattman.
is. We certainly did not until fairly recently. blogspot.com.
If you use Google Maps, you will see Lesotho is a
small, independent, basically black, mountain kingdom The setting is an interfaith network of Liberian
entirely inside the country of South Africa. The popula- religious leaders who are talking about their
tion of Lesotho is about 2 million, but it has been declin- peace-building plans. They are a truly inspiring
ing because of the AIDS epidemic, with estimates that as organization, building local capacity to resolve
high as 30% of young adults are infected. Unlike in the conflicts and training mediators to resolve disputes
United States, the transmission of AIDS is largely through in the community. The countryside is, to some
heterosexual sex. Because the country is very poor, many extent, a powder keg, and they are building local
of the men have gone to South Africa to work, often in the early warning systems and rapid response capability
diamond mines. They may have brought AIDS home with to deal with potentially serious conflicts.
them. In any case, the AIDS infection in South Africa may
be even worse than in Lesotho. To reduce tensions in conflict-prone places,
What can someone who is not a health professional these religious leaders—principally Muslims and
(and we are not) do in the presence of an AIDS epidemic? Christians—do not just aspire to a new social
After all, we are the wrong kind of doctors. The answer is contract; they sit down with ethnic and religious
not as much as our heart would wish. But to do nothing is, leaders in each village and coax them to actually
as John F. Kennedy incorrectly quoted Dante as saying in write one, specifying norms and sanctions. And
Inferno, “to be consigned for all eternity to reside just inside they want to know if it’s working.
the Gates of Hell.”
Well, we did what statisticians know best: studied At one of their gatherings, there was some
the problem statistically, tried to find its shape, and humming and hawing about how to evaluate
detailed its scope. When resources are limited, and they whether the interventions were working. The idea
always are, an effort to find what does not work or what of experimentation comes up. Then, something
works better can be a way to make what is available go truly unexpected happens. “Wait a minute,”
further, to convincingly use resources more frugally, interrupts an imam. “Are you talking about a
and—by dealing with matters hardheadedly—to reach a randomized control trial?”
heart that might otherwise not have been softened. Put
another way, the injunction to “harden not your heart” “Oh, I see!” says one reverend minister. “We need
applies not only to us as individuals when faced with a control group! This is a good idea.” It turns out
tragedy, but conveys a social obligation to help others, as his holiness was once an agronomist. “This is just
well. Maybe this is a clear instance when the injunction like our control plots for fertilizer. But, how are
“Thou should neither sit with statisticians nor commit a we going to control for spillover effects?”
social science” is not normative.
The need for a rigorous evaluation of good intentions An older Methodist leader sitting in the corner
may seem paradoxical. After all, we have been told it is the glowers. “Please, a moment,” he says. “I see a real
thought that counts. However, great harm can sometimes problem here.” Here it comes. Here is where the
be done as a result of the unintended consequences of good expected doubt and questioning arises? We’re
intentions. Sadly, examples abound, especially when work- talking about a peace-building exercise, after all,
ing cross-culturally. not fertilizer on a farm plot. This man, of an older
We are recommending for Lesotho that, to carry out generation, clearly has other priorities. “How,” he
the evaluation, the assistance of a conventional random- asks “are we going to select a proper sample?”
ized design be used. In particular, we are randomly divid-
ing up the health clinics to be renovated into those to be Safaa Amer and Fritz Scheuren
32 AMSTAT NEWS MAY 2008
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